Provider Demographics
NPI:1144062860
Name:VIERA, JACKLYN
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:VIERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 GLEN MOOR LN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4912
Mailing Address - Country:US
Mailing Address - Phone:727-992-3148
Mailing Address - Fax:
Practice Address - Street 1:924 HALE AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3642
Practice Address - Country:US
Practice Address - Phone:813-748-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician